What is total and permanent disablement?

Event one

At the date you suffered an injury or illness or cease work if that’s later, you were  64 years of age or less and employed for at least 15 hours per week (or on average over your roster cycle) immediately before you were disabled (or employed for at least 15 hours per week within the 12 month period prior to suffering an injury or illness) and, because you were sick or injured, you have been absent from all work for six consecutive months and the insurer considers on the basis of medical and other evidence, that you are unlikely ever to be able to engage in any 'Occupation'.

What does ‘Occupation’ mean?

  • for a mining industry employee, professional or senior management, the person’s occupation based on the general area of expertise of the person, otherwise
  • an occupation that the person can perform, on a full time or part time basis, based on the skills and knowledge the person has acquired through previous education, training or experience.
Notes: Mining industry employee means the member has been working within the Australian mining industry (including mining other than coal mining) as an:
  • employee with at least 5 consecutive years’ service, or
  • apprentice with at least 4 years’ service out of the last 5 years, or
  • employee with at least 5 years’ service out of the last 8 years.
'Professional' means a person who:
  • has a university degree
  • belongs, or is eligible to belong, to a professional body
  • earns a salary greater than $60,000 pa, and
  • only works in an office environment and in a sedentary capacity.
'Senior management' means a person who:
  • is part of the senior management of an employer
  • earns a salary greater than $60,000 pa.

Event two

The insurer is satisfied on medical and other evidence that you’ve suffered, as a result of sickness or injury:
  • the total and permanent loss of the use of two limbs
  • blindness in both eyes
  • the total and permanent loss of the use of one limb and blindness in one eye.

where limb means the whole hand below the wrist or whole foot below the ankle; and blindness means the permanent loss of sight to the extent that visual acuity is 6/60 or less, or to the extent that the visual field is reduced to 20 degrees or less of arc.

Event three

Because of illness or injury, for six consecutive months from the date of disablement, you have been totally unable to perform without the physical assistance of another person any two of the following activities of daily living and you’re permanently and irreversibly unable to do so for life:
  • dressing – the ability to put on and take off clothing
  • toileting – the ability to use the toilet, including getting on and off
  • mobility – the ability to get in and out of bed and a chair
  • continence – the ability to control bowel and bladder function
  • feeding – the ability to get food from a plate into the mouth.

Event four

You’re under age 64 when suffering an injury or illness and because of one of the medical conditions below, you’re:
  • away from all work, and
  • on the basis of medical and other evidence satisfactory to the insurer,  in the opinion of the insurer you are unlikely ever to be able to engage in any occupation that you can perform, on a full time or part time basis, based on the skills and knowledge you’ve acquired through previous education, training or experience, whether or not for reward, and
  • likely to be disabled for life.

Medical conditions

  • cardiomyopathy
  • primary pulmonary hypertension
  • major head trauma
  • motor neurone disease
  • multiple sclerosis
  • muscular dystrophy
  • paraplegia
  • quadriplegia
  • hemiplegia
  • diplegia
  • tetraplegia
  • dementia and Alzheimer's disease
  • Parkinson's disease
  • blindness
  • loss of speech
  • loss of hearing
  • chronic lung disease
  • severe rheumatoid arthritis

Event one

At the date you suffered an injury or illness or cease work if that’s later, you were 64 years of age or less, and:
  • ‘gainfully working’ for at least 15 hours per week on the day immediately before you were disabled, or
  • employed for at least 15 hours per week (or on average over your roster cycle) within the 12 consecutive months immediately prior to your being disabled, and
  • because you were sick or injured, you have been absent from all work for 183 consecutive days and the insurer considers that due to your sickness or injury and on the basis of medical and other evidence they find satisfactory, that you are unlikely ever to be able to work in any ‘gainful employment’ for which you are reasonably qualified by education, training or experience.

‘Gainful employment’ means any occupation that you can perform on a full or part-time basis

‘Gainfully working’ means employed or self employed for reward or financial benefit, or the hope of reward or financial benefit, in any business, trade, profession, vocation, calling, occupation or employment or on employer approved leave (excluding sick leave).  Employer approved leave must be approved prior to the start of that leave.

Event two

Because of illness or injury and for 183 consecutive days from the date of disablement, you have been totally unable to perform at least two of the 'activities of daily living' without the assistance of another person or suitable aids, and are:
  • permanently and irreversibly unable to perform at least two of the 'activities of daily living', and
  • unlikely to ever work in any ‘gainful employment’ for which you are reasonably qualified by education, training or experience.
'Activities of daily living':
  • bathing – bathing and showering
  • dressing – dressing and undressing
  • feeding – eating and drinking
  • mobility – to the extent of being able to get in and out of bed or a chair and move from place to place without using a wheelchair
  • toileting – the ability to use a toilet.

Event three

You are under age 65 and you suffer an injury or illness and because of one of the medical conditions below:
  • you're away from all work, and
  • the insurer considers, on the basis of medical and other evidence they find satisfactory, that as a result of one of the listed medical conditions below, you are unlikely ever to work in any ‘gainful employment’ for which you are reasonably qualified by education, training or experience and are likely to be disabled for life.

Medical conditions:

  • cardiomyopathy
  • primary pulmonary hypertension
  • major head trauma
  • motor neurone disease
  • multiple sclerosis
  • muscular dystrophy
  • paraplegia
  • quadriplegia
  • hemiplegia
  • diplegia
  • tetraplegia
  • dementia and Alzheimer's disease
  • Parkinson's disease
  • blindness
  • loss of speech
  • loss of hearing
  • chronic lung disease
  • severe rheumatoid arthritis.